Weathering the Storm: Cloud Technology & Disaster Recovery
At 2:46 p.m., March 11, Shigeru Ehara, MD, heard his phone alarm unexpectedly go off. He was working in the radiology department at Iwate Medical University in Morioka, Japan, and discovered the alarm was part of an earthquake alarm service, indicating a strong quake had just occurred.

After the earthquake and tsunami, the hospital was left without electricity, and limited emergency power capacity had slowed normal imaging services. The PACS was disabled, interpretations were rendered orally and memos were left on requisition forms.

This disaster provides a stark reminder that all medical imaging providers need to have a comprehensive disaster recovery plan that accounts for data protection, as well as allowing operations to continue at the highest level allowed by the situation.

As far as protecting data, in recent years, more facilities have turned to virtualization and cloud data storage as part of that plan. A 2011 survey of 1,200 IT professionals conducted by CDW Healthcare showed that one-third of healthcare organizations are implementing or maintaining cloud-based systems. Thirty-seven percent said they are developing a written strategic plan for the adoption of cloud computing.

Virtualization of servers is on the rise as well, as 89 percent of hospitals with 50 beds or more surveyed by CDW had at least one form of virtualization in place.

Typically, the top reasons for healthcare enterprises to turn to the cloud, where patient images and other data are archived on outside servers, and other offsite data strategies, have been the potential benefits in cost reduction and the flexibility that comes with expanded access.

More IT staffs, however, are recognizing the benefits cloud technology can have in terms of protecting and recovering data in the event of a disaster. A survey conducted at the 2011 Healthcare Information Management and Systems Society (HIMSS) conference showed that more than half of respondents who are using or are considering plans to use a cloud vendor for medical images said one of their major concerns was disaster recovery.

James P. Borgstede, MD, chair of the American College of Radiology (ACR) Foundation's International Outreach Committee, who has recently been involved with the ACR's relief work in Haiti, following the devastating earthquake of 2010, says it is important for facilities to know the strengths and weaknesses of their local PACS or offsite data storage system. In the film era, in the event of a power outage, there were hard copies of images.

"In that sense, there was an advantage to the old way of doing things," says Borgstede. "However, the disadvantage is that there's no way to transport those data electronically. So, if your systems were up and running but you needed interpretive support, there was no way to get that. You had to bring people into the disaster area, where now you have the opportunity to send the films outside the disaster area."

From quakes to snowflakes

It doesn't take a devastating earthquake to disrupt normal workflow; sometimes it can be a more common occurrence like a heavy snowstorm. That's what Oklahoma City-based Eagle Imaging Partners had to deal with in February.

Eagle Imaging primarily serves the state of Oklahoma, but also some hospitals in Kansas and Texas. It is an onsite group, but it utilizes a teleradiology distribution model and sends images to a vendor-supported cloud. Images are then brought back to workstations where physicians can access them at all locations with the same platform and workflow.

Eric Slimmer, Eagle Imaging's CEO, says the rural practice serves a number of facilities that are a significant distance from the larger metro areas, which could have been a problem when the region was hit by a "crippling" blizzard.

Many highways and interstates were shut down, some for two days, but Eagle Imaging was able to continue to provide interpretations using the cloud-based system. Some physicians provided interpretations from their homes.

"Cloud technology enabled us to provide a continuum of care to the rural hospitals that we cover," says Slimmer, adding that a number of imaging centers were closed, but the hospitals remained open. "Our group was able to continue to provide care in the middle of this blizzard. In the past, we wouldn't have been able to do that and hospitals would have had to go on divert and cease radiology reading."

Tiptoeing into the cloud

Not every organization is ready to jump headfirst into the cloud. This month, University of Massachusetts (UMass) Memorial Health Care in Marlborough, Mass., will implement partial virtual storage in a vendor-supported cloud service. UMass plans to move clinical apps, pharmacy, billing and patient registration to the cloud, but Rick Mohnk, associate CIO at UMass, is a little hesitant to shift everything to the cloud. "I'm not quite ready to run my PACS images out to the cloud," says Mohnk, adding that the cost-effectiveness of the approach has not been definitively proven. While some large industries with a single core competency may see great cost-benefits with cloud storage, a healthcare enterprise consists of dozens of departments with different needs, he says.

Mohnk isn't alone. The HIMSS survey found that one in five respondents were concerned with the cost effectiveness of cloud storage. Mohnk doesn't rule out moving more data to the cloud, but would like vendors to allow more flexibility in provisioning data between local storage and the cloud, giving CIOs more control.

He says that there are many ways to protect and back up data in the event of a disaster. If a facility has only a single data center, it can include servers with dual power supplies, dual CPUs and dual net cards to maximize uptimes. Enterprises can use multiple storage area networks (SANs), with each performing different roles.

Prior planning is essential in creating disaster recovery plans. For example, with Hurricane Irene bearing down on the Northeast in August, Mohnk and his staff met daily to discuss preparations. They had previously established three remote geo-clustered data centers to back up data and minimize the risk of data loss, and in advance of Irene, they created a mini command center, where they could address any issues that might arise.

Healthcare IT departments should formulate a vision ahead of time, and know its limitations, Mohnk says. Budgets are a concern and small community hospitals may not be able to afford a high-availability, fully redundant, geo-clustered data center. Organizations should define their needs, says Mohnk. "Put the plan in place. Talk to the leadership. Get the board onboard."

Beyond the cloud

Disaster planning also includes workflow and contingency plans for staff, says Pam Matthews, senior director of regional affairs for HIMSS. Everyone from radiologists to nursing assistants needs to know his or her role. A facility needs to know how it will transport patient data in the event of evacuations, and have a plan for all types of interruptions, even if it's simply unscheduled downtime for email services.

Some organizations may leverage cloud technology to protect data, says Matthews, but she says decisions about budget and the amount an organization is willing to risk in protecting assets must be made well in advance of any unexpected shutdown.

"The challenge, especially for a CIO, is to develop an understanding within the organization of the importance of disaster recovery," says Matthews.

Advanced planning, an organizational disaster plan and ongoing data protection strategies, including those that leverage cloud technology, can help healthcare providers fulfill Matthew's personal mantra, which is that you can't stop delivering care, even in a disaster.